Grand Rounds Recap 4.18.18

Grand Rounds Recap 4.18.18

This week we got a refreshing look at soft tissue ultrasound from our US guru Dr. Stolz. We then moved to the opposite end of modern imaging with the rarely indicated but intermittently very useful KUB by Dr. Skrobut. Drs Kiser and Ventura battled it out in a CPC case of pyloric stenosis then the R4s ran a simulation and small group on global health pathologies.

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EM Diagnostics: Pleural Fluid and Ascitic Fluid Analysis

EM Diagnostics: Pleural Fluid and Ascitic Fluid Analysis

Paracentesis and thoracentesis are relatively common procedures in the Emergency Department but the analysis of the fluid can always but a touch confusing.  In this post, PGY-1 Dr. Michael Klaszky walks us through the analysis of pleural fluid and ascitic fluid.

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Thoracentesis

Thoracentesis

General Considerations

Both the diagnostic and therapeutic thoracenteses are performed using a similar technique. The major difference is the amount of fluid removed. The proceduralist may also choose to only use the needle technique as opposed to the needle-catheter unit when obtaining fluid for diagnostic purposes only.

It is generally recommended that needle size be limited to 18-gauge or smaller to minimize risk of pneumothorax and damage to nearby structures.

US-guided thoracentesis is associated with a significantly lower rate of complications and has become the standard of care. (1)  Real-time ultrasound (US) guidance is recommended for small or loculated effusions when there is concern that the diaphragm or lung tissue is <10mm from the pleural surface. It is also recommended in patients with relative contraindications such as coagulopathies and the mechanically ventilated patient.

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